title: New therapeutic options for allergic rhinitis: back to the future with intranasal corticosteroid aerosols.
abstract: BACKGROUND
  Under current guidelines, intranasal corticosteroids (INSs) are considered the most effective first-line therapy to improve allergic rhinitis (AR) symptoms and burden of disease. In the late 1980s-1990s, chlorofluorocarbon (CFC)-propelled corticosteroid aerosol nasal sprays formed the standard of care for the treatment of AR. Because of environmental concerns, CFC aerosols were gradually phased out, and aqueous INS formulations of nasal sprays became the standard of care. Although many aqueous INS sprays are available, specific product-related factors can reduce patient adherence to an INS and subsequently reduce treatment efficacy. The purpose of this paper was to review the evolution of AR therapeutics and drug devices and how it may have an effect on patient adherence/compliance and patient satisfaction with current available therapies and show the unmet need to improve INS delivery systems.
  
  
  METHODS
  Although aqueous INSs are effective and well tolerated, use in some patients may be compromised because of patient sensory perception and device preference. A historical review of the evolution of intranasal delivery of INSs was undertaken to provide further insight into improving treatment options for patients with AR.
  
  
  RESULTS
  Although the various approved INSs appear to be equivalent in terms of reducing AR disease burden, the method in which an INS is delivered to a patient has significant bearing on the overall success of each specific drug product.
  
  
  CONCLUSIONS
  Hydrofluoroalkane-propelled INS drug products offer a back-to-the-future delivery approach that may be further tailored to the individual patient's needs. Past experiences and the development of new devices are paving the way toward further therapy choices, ultimately affording health care providers access to the most effective treatments for patients with AR.
authors.affiliation: Allergy & Asthma Associates of Southern California, 27800 Medical Center Road, Mission Viejo, CA 92691, USA. warnercarr@hotmail.com
authors.forename: Warner W
authors.initials: WW
authors.lastname: Carr
mesh_terms: D000281:Administration, Intranasal / Q000009:adverse effects / Q000379:methods; D001507:Beclomethasone / Q000008:administration & dosage*; D019317:Evidence-Based Medicine; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D059085:Nasal Sprays; D011282:Pregnenediones / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic; D065631:Rhinitis, Allergic; D012221:Rhinitis, Allergic, Perennial / Q000188:drug therapy*; D006255:Rhinitis, Allergic, Seasonal / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D059085:Nasal Sprays; D011282:Pregnenediones; D001507:Beclomethasone; C120481:ciclesonide